Content Overview 
- Adverse Determination
- Annual Limits
- Case Manager
- Certificate of Creditable Coverage
- Coordination Of Benefits
- Co-Insurance
- Co-Pay
- Covered Charges
- Department Of Insurance
- Deductible
- Eligibility
- Experimental Treatment
- Explanation Of Benefits
- Extensions
- Fee-For-Service (Indemnity)
- Formulary
- Lifetime Limits
- HMO
- Medical Necessity (Medically Necessary)
- Out Of Network
- Out-of-Pocket Maximum (also known as "Stop Loss" or "Cap")
- Palliative Care
- POS
- PPO
- Renewability
- Pre-Existing Health Condition
- Stop Clause (also known as "Stop Loss Clause")
- Underwriting (What It Is And How It Works)
- U.S. Department Of Labor
- Usual, Customary and Reasonable "(UCR")
- Utilization Management
Glossary of Health Insurance Terms To Know
Medical Necessity (Medically Necessary)
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The concept of medical necessity is used by insurers to determine whether to pay for a particular medical treatment. If the treatment is not "medically necessary," the insurer doesn't pay. There is no clear-cut, industry wide definition of "medical necessity."
The definition of "Medical Necessity" depends on the context and who is making the decision. The basic concept is that medically necessary services are those services which are reasonable and necessary or appropriate based on current clinical standards of care.
If a drug or treatment is optional, it is not covered. For example, plastic surgery to get rid of lines around the eyes is not "medically necessary" so it is not covered by health insurance.
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